Inducing Labor – Why, When and How

Sometimes, the birth process isn't taking place in the smooth, natural way that Nature intended. In these cases, medical intervention can step in and jump-start the process through a process known as "induction," or more commonly, "inducing labor."  While usually this is done because of a medical emergency, sometimes the mother might simply choose the process (in which case, it's considered an elective procedure).  Historically, induction has been reserved to crisis situations.  Convenience induction has been rising in popularity in recent decades, though, so that the birth can take place at a more convenient time. Still, the ACOG (American College of Obstetricians and Gynecologists) recommends that labor only be induced when it's risky to do otherwise. Here are what are considered the legitimate reasons for induction of labor:

• A complication such as preeclampsia, hypertension, gestational diabetes, heart disease or bleeding threatens the pregnancy.
• The baby is at risk of having his oxygen obstructed or of getting an insufficient amount of required nutrients from the placenta.
• Labor has not started within 24 or 48 hours of the amniotic sac rupturing.
• The pregnancy has gone on for more than 42 weeks.
• Chorioamnionitis, a type of infection, has been detected in the uterus.
  If any of the above conditions exists, labor is likely to be induced by one of these methods:
• Medications.  These could include any of the following: 1) Oxytocin, which is given at low doses via an IV in order to stimulate the mother's contractions; 2) Prostaglandin.  This is a suppository that's placed into the mother's vagina in the evening.  Its purpose is to make the uterus go into labor before morning time. This method has the advantage of freeing the mother to walk around the room if she chooses.
• AROM ("Artificial Rupture of Membranes"). When the amniotic sac ruptures, the body produces the hormone prostaglandin in an increased amount. This speeds up contractions.  A doctor might, depending on the circumstances, recommending having the amniotic sat artificially ruptured. This is done by using a sterile, thin hook to brush the membranes inside the mother's cervix. After this, the baby's head will move against the cervix.  This will cause a strengthening of the contractions. Finally, there will be a release of amniotic fluid out of the vagina. There are both advantages and disadvantages to this second approach. The advantages are that it might shorten labor by as much as an hour, it allows the doctors to examine the amniotic fluid for meconium (a possible indicator of fetal distress), and the doctors can monitor the heart rate directly.  The disadvantages to the approach are that the baby might turn and make it harder for birth to take place if the medical staff ruptures the sac before the child's head is engaged; it might also cause the umbilical cord to come out first; or there might be infection if too much time passes between the rupture and the birth.
• Nipple Stimulation. This can be done with a breastfeeding pump or manually. In this method, the hormone oxytocin is produced and causes contractions.

If you do agree to induce labor, you will still be able to do breathing exercises and to push at a rate that fees comfortable to you, if you choose not to use pain medications. You will, however, be given the option of taking an epidural anesthetic or other kind of pain relief.

Above all, if induction of labor is necessary, stay calm and cooperate with all of your doctor's instructions.  This will give you the best chance of getting through the procedure safely with no harm done to either you or the child.